Provider Demographics
NPI:1578896700
Name:BONDY, TIMOTHY IVAN (PT)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:IVAN
Last Name:BONDY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:339 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9259
Mailing Address - Country:US
Mailing Address - Phone:231-487-4638
Mailing Address - Fax:231-487-4615
Practice Address - Street 1:1333 SPRING ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-8720
Practice Address - Country:US
Practice Address - Phone:231-487-4638
Practice Address - Fax:231-487-4615
Is Sole Proprietor?:No
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010014552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI23-6707Medicare PIN